Author + information
- Received May 6, 2016
- Accepted May 20, 2016
- Published online September 12, 2016.
- Chi Yuen Chan, MBChB∗ (, )
- Eugene B. Wu, MD and
- Bryan P. Yan, MBBS
- Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, People’s Republic of China
- ↵∗Reprint requests and correspondence:
Dr. Chi Yuen Chan, Division of Cardiology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, 9/F Clinical Science Building, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, NT, Hong Kong SAR, China.
A 61-year-old woman presented to a rural hospital with inferior ST-elevation myocardial infarction 13 months after uncomplicated elective percutaneous coronary intervention with implantation of a 3.5 × 28-mm Absorb bioresorbable vascular scaffold (BVS; Abbott Vascular, Abbott Park, Illinois) in the right coronary artery for stable coronary artery disease (Figures 1 and 2, Online Videos 1 and 2). The patient completed 12 months of dual antiplatelet therapy up to 1 month before this presentation. Thrombolysis was administered followed by transfer to our hospital for percutaneous coronary intervention. Coronary angiogram showed haziness at the proximal segment of the BVS (Figure 3, Online Video 3). Coronary wire and optical coherence tomography (OCT) catheter were carefully advanced beyond the BVS. The OCT imaging showed intraluminal scaffold dismantling at the proximal segment of the BVS with adherent white thrombi (Figures 4 and 5, Online Video 4). Ticagrelor has been resumed for another 3 years. Follow-up OCT at 3 years has been arranged.
Scaffold disruption could be caused by extreme overexpansion of the BVS during implantation. Late scaffold discontinuities have been observed in approximately 40% of patients treated with the Absorb BVS, which may be viewed as a normal bioresorption process without clinical implications (1). Both scaffold discontinuities and intraluminal scaffold dismantling have been observed in a case series of very late scaffold thrombosis (2). However, in this case series, baseline OCT was not available and index OCT images were obtained after the passage of a thrombus aspiration catheter which may have caused damage to the partially resorbed struts. Therefore, the mechanism of late BVS thrombosis remains unclear.
In our case, the scaffold was optimally post-dilated within the post-dilation size limit and baseline OCT confirmed full apposition and optimal expansion of the scaffold. Intraluminal scaffold dismantling still occurred, which served as a nidus for thrombus formation. This case raises concerns on the risk of very late thrombosis when late discontinuities occurred at the site without complete endothelialization. Prolonged dual-antiplatelet therapy may be warranted in these cases.
For supplemental videos and their legends, please see the online version of this article.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 6, 2016.
- Accepted May 20, 2016.
- 2016 American College of Cardiology Foundation
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